青春期多囊卵巢综合征的诊治

由于青春期多囊卵巢综合征（PCOS）的病理变化与正常青春期生理变化相似,2012年提出青春期PCOS的诊断应同时符合Rotterdam标准的3个指标,即初潮后2年仍存在月经稀发或闭经、超声下多囊样卵巢（PCO）改变（包括卵巢体积＞10 cm3）和高雄激素血症。尽管代谢因素不是PCOS 的诊断指标,但仍应注意青春期PCOS患者代谢紊乱的发生情况。而青春期PCOS的治疗包括：生活方式调整,筛查并早期干预代谢紊乱,纠正月经周期紊乱。     

胰岛素抵抗在多囊卵巢综合征诊断中的意义

多囊卵巢综合征是人类常见的内分泌疾病之一.诊断标准中,多囊卵巢综合征主要以高雄激素症状为特征,而没有把胰岛素及代谢参数的评估纳入,大多数多囊卵巢综合征患者存在胰岛素抵抗、肥胖、高脂血症等代谢综合征的特征.多囊卵巢综合征与2型糖尿病密切相关,但是否为心血管疾病的诱因还不太清楚.在多囊卵巢综合征的发病中强调胰岛素抵抗的重要性,不仅能使诊断更有说服力,而且能预防心血管疾病的高危因素.对多囊卵巢综合征患者进行代谢症状的综合评价,有助于识别心血管疾病的高危因素,并进行恰当的治疗.对于肥胖的多囊卵巢综合征患者,改变生活方式仍然是首选方法,但通常这些患者很难减轻体重.胰岛素增敏剂是长期治疗多囊卵巢综合征主要和唯一的方法.     

36例青春期多囊卵巢综合征的干预与治疗

目的:探讨青春期多囊卵巢综合征(PCOS)的干预与治疗。方法:选择36例青春期多囊卵巢综合征患者口服妈富隆或妈富隆联合二甲双胍治疗3个周期,对比治疗前后女性激素及胰岛素的改变。结果:36例患者完成3个周期治疗后观察2个月,36例月经不规则患者中83%月经周期正常,与服药前比较黄体生成素(LH)、睾酮(T)均有显著降低(P<0.05),卵巢体积显著减小(P<0.05)。肥胖及空腹胰岛素(INS)>14 mmol/L的患者两种药物+饮食限制+运动3个周期后65%体重指数(BMI)下降,90%空腹INS<9 mmol/L。结论:妈富隆或妈富隆联合二甲双胍对纠正青春期PCOS患者的异常血激素相及卵巢形态有良好的效果。     

青春期多囊卵巢综合征诊断与治疗

本文介绍了青春期多囊卵巢综合征的特征及发病机制,提出早期诊断及治疗青春期的多囊卵巢综合征,对阻断和纠正其内分泌紊乱,防治与胰岛素抵抗密切相关的代谢综合征的发生发展极为重要。     

多囊卵巢综合征蛋白质组学的研究现状

多囊卵巢综合征(PCOS)是一种复杂、多因性的内分泌紊乱和代谢性疾病。PCOS患者具有排卵功能障碍、高雄激素血症或高雄激素表现、多囊卵巢形态等特点,主要临床症状为超重或肥胖,其中50%~70%的PCOS患者合并胰岛素抵抗和代偿性高胰岛素血症。目前,蛋白质组学研究被越来越多地应用于PCOS的诊断和治疗。笔者拟就目前PCOS蛋白质组学研究的常用技术进行概括,从发病机制、诊断标志物及远期并发症的3个方面对PCOS蛋白质组学的研究现状进行总结,并对PCOS的研究前景进行展望。     

青春期多囊卵巢综合征的研究进展

多囊卵巢综合征（ PCOS）是育龄期女性常见的内分泌疾病,主要表现为月经稀发、痤疮、多毛、肥胖、黑棘皮症等,其一旦确诊意味着远期发生不孕、子宫内膜增生/肿瘤、代谢综合征、2型糖尿病和心血管疾病的风险增高。 PCOS的发病从青春期开始,严重危害着青春期女性身体健康的同时也给其造成了一定的心理问题。青春期PCOS的发病机制中,胰岛素抵抗及高雄激素起至关重要的作用,青春期PCOS的诊断标准在临床上已具有较大的认可度,但仍需要进一步证实,治疗干预则首先从调整生活方式做起,辅以药物治疗,而患病人群心理干预的重要性也逐渐为研究者所重视。该文主要针对青春期PCOS的最新研究成果展开讨论,从发病机制的研究进展、诊断标准的变迁、目前的治疗策略进行逐项分析。     

多囊卵巢综合征与青春期功血的相关性

目的 比较多囊卵巢综合征患者、青春期功能失调性子宫出血(功血)患者和正常女性的临床资料及实验室检查结果 ,并分析三者之间的相关性,为多囊卵巢综合征和青春期功血的诊断、治疗提供新思路.方法 选择76例月经失调患者和25例同龄正常女性的临床资料,对所有受试者的初潮年龄、临床表现、发病年龄、B型超声结果 、性激素变化以及口服葡萄糖耐量和胰岛素释放试验结果 等进行分析.结果 ①青春期月经失调患者中59.21%为多囊卵巢综合征,28.95%为功血;② 3组患者中多囊卵巢综合征组胰岛素抵抗者明显增多(t=5.63,P<0.05),青春期功血组次之,正常对照组最少;③多囊卵巢综合征组患者血清睾酮水平和黄体生成素/卵泡刺激素明显高于正常对照组(t分别为4.98、3.85,均P<0.05),以青春期多囊卵巢综合征组增高更为明显;④多囊卵巢综合征组患者B型超声检查示双侧(或单侧)卵巢体积较功血组明显增大,小卵泡增多(t=9.84,P<0.05).结论 青春期月经失调患者中多数为多囊卵巢综合征,其次为功血.月经失调伴高雄激素血症患者应常规检查血口服葡萄糖耐量和胰岛素释放试验,并应重视对胰岛素抵抗的治疗.     

青春期多囊卵巢综合征诊断标准的现状分析

多囊卵巢综合征是育龄妇女中最常见的内分泌疾病,在青春期表现尤其明显.目前,成年多囊卵巢综合征的诊断标准已经明确.随着近年青春期多囊卵巢综合征发病率的逐渐提高,急需建立适合青春期多囊卵巢综合征的诊断标准.现讨论高雄激素血症、闭经和卵巢呈多囊性改变等在青春期多囊卵巢综合征诊断中的重要意义.     

青春期多囊卵巢综合征的筛查

多囊卵巢综合征好发于青春期,以高雄激素血症和高胰岛素血症为特征.目前发现青春期多囊卵巢综合征患者在其青春期后发展为2型糖尿病,心血管疾病,以及不孕症的危险性增加,而且多囊卵巢综合征的一些症状对于青少年身心健康是有害的.所以做出青春期多囊卵巢综合征的早期诊断是重要的,为了达到提高早期诊断的目的,筛查就显得尤为重要.该文将对青春期多囊卵巢综合征的筛查做如下论述.     

胰岛素增敏剂对多囊卵巢综合征患者诱发排卵的作用

胰岛素抵抗是造成多囊卵巢综合征（PCOS）患者生殖和代谢功能障碍的主要原因。通常用胰岛素增敏剂如二甲双胍或噻唑烷二酮类药物来治疗PCOS患者，单独用胰岛素增敏剂就有一定的促排卵作用。但是，联合其他药物还能提高生殖力和降低卵巢过度刺激综合征（OHSS），而且，还有可能降低孕期并发症。研究证明PCOS患者应在发病早期就开始用二甲双胍来治疗。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.